Abstract
We report a non-ketotic, hyperosmolar diabetic coma which was preceded by the administration of L-asparaginase in a diabetic patient with acute lymphoblastic leukemia and Down's syndrome. A 19-year-old man was admitted to the hospital for the treatment of acute lymphoblastic leukemia. He had Down's syndome and hypothyroidism, and his blood glucose concentrations ranged from 110 mg/dl to 140 mg/dl.
He received intravenous injections of L-asparaginase (500 KU each) on October 16 and 18. On October 19, he was found unconscious when his blood glucose rose to 1100 mg/dl. Urinalysis, however, yielded a negative result for ketone bodies. We immediately started intrvenous administration of insulin and saline. Plasma osmotic pressure was 329 mosm/L, although it was determined after he received about 800 ml of saline infusion.
He responded well to insulin treatment and regained consciousness on October 23. On Novemer 6, we stopped insulin administration because of an improved blood glucose level. Binding of 125I. insulin to his erythrocytes was within normal limits, suggesting that the number of insulin receptors on his red blood cells was normal.
